By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses the most advanced diagnostic and healing approaches for endoscopists. It presents the newest considering and transparent guideline at the concepts, that have been built-in with total sufferer care.
Written by way of the major foreign names in endoscopy, the textual content has been expertly edited via Peter Cotton right into a succinct, instructive structure. offered briefly paragraphs based with headings, subheadings and bullet issues and richly illustrated all through with full-color pictures.
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Additional resources for Advanced Digestive Endoscopy: ERCP
Minor papilla cannulation The minor papilla is located proximally and to the right of the main papilla. It can be identiﬁed as a small protruding structure. It may not be obvious or may appear as a slightly pinkish nipple between the duodenal folds. When prominent, it can sometimes be mistaken for the main papilla; however, it does not have a distinct longitudinal fold and the small opening usually resists cannulation. Cannulation of the minor papilla is indicated in patients with suspected or proven pancreas divisum and when cannulation of the pancreatic duct fails at the main papilla.
The ﬂexible tip guidewire is inserted through a catheter or a sphincterotome and 5 mm of the tip is pushed gently in the direction of the CBD. It is important that the endoscopist or an experienced assistant performs the initial gentle probing (or exploration) at the papillary oriﬁce with the guidewire as the feel and control of the catheter/guidewire are important. When the tip of the guidewire is advanced without any resistance, the catheter is passed over the guidewire into the ductal system.
12). Failure to ﬁll the gallbladder despite adequate ﬁlling of the intrahepatic ducts suggests cystic duct obstruction. Stone impaction in the FUNDAMENTALS OF ERCP cystic duct may cause edema and compression of the common hepatic duct giving rise to Mirizzi’s syndrome. Underﬁlling and delayed drainage With an adequate intrahepatic cholangiogram, underlying parenchymal liver diseases may be inferred from abnormal appearance of the intrahepatic ducts. Crowding of tortuous intrahepatic ducts may suggest liver cirrhosis.
Advanced Digestive Endoscopy: ERCP by Peter B. Cotton